HomeMy WebLinkAboutMortgage_Dixon (2) n4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
' tjP, ii+ State Form 43709(R12/6-14)
•' - Prescribed by Department of Local Government Finance FIT / ED-
INSTRUCTIONS: 8 File Mark
To be filed in person or by mail. JUN 8 _Gib fled with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prope/ is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auer tl�
where the properly is located during the hvelve(12)months before March 31 of each year the 6L , /dNsG&DiihNTY AU UI 1 OR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract q�r-see restrictions on reverse side) //,,
ii )( C 1n tIc1, C . Qry&.L k4r) 1 , U. utyclt)
Twang District I Key number/legal description R number Page
F+ .Qsa1,oh c(D-ICI -IX-3cc, .C�cxm - tolr�oc o )I. �(�
Assessed value d real property as d Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,cement year March
1,anent year cc) date of application legal or equitable owner?
od 7 / 5-51 [WYes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
mReal Property ❑ AnnualiyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller l
CATOr+c ;ca (- cIS-1-LO,A/N oL \DnhU�,.(0
Address of mow ntrect seller(number and street dry, dte,and ZIP code)
.SCE I N Crc tsc pill n+e LJ U vd -J It fljy i )Qt �I t-hn IT
Name of assignee or other owner or holde t of mortgage r
Address of assignee(number and street city,stare,and ZIP code)
Does apparent own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,—, property for
in Indiana? Yes ❑No current year? ❑
di Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount ot.
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer f the aforementioned property on date application is filed.
Signature(owners full e) / Date(month,day,year)
X al ill I Full re • address zant(number and street,ci�j state,and'{PP code) r� I
7o t �At_nk• , , -.61 �- 5tanlrL 0 41 _0gX
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street thy,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 310,000.